A 12-week study comparing moclobemide and sertraline in the treatment of outpatients with atypical depression.

One hundred and ninety-seven outpatients with atypical depression [Atypical Depression Diagnostic Scale (ADDS) score=4] were randomized to 12 weeks of double-blind treatment with sertraline or moclobemide in a multicentre, parallel-group clinical trial. Patients were started on either 50 mg/day sertraline or 300 mg/day moclobemide. If the therapeutic response was not satisfactory after 4 weeks, the dose could be increased to either 100 mg/day sertraline or 450 mg/day moclobemide. Primary efficacy evaluations were the 29-item Hamilton Psychiatric Rating Scale for Depression (HAM-D) and the Clinical Global Impression of Improvement (CGI-I) response rate (much or very much improved) at study endpoint. Secondary efficacy evaluations included the ADDS, the Hamilton Anxiety Scale (HAMA), the Leeds Sleep Scale, and the Battelle Quality of Life Battery (BQOLB). In the analysis of the 172 patient efficacy-evaluable population, there was significant baseline to endpoint improvement in all primary and secondary efficacy assessments after treatment with either sertraline or moclobemide. At the endpoint, the proportion of responders on CGI-I, was 77.5% in the sertraline group and 67.5% in the moclobemide group (p=0.052). The baseline to endpoint mean 29-item HAM-D score decreased from 35.9 to 14.5 in the sertraline group and from 36.3 to 16.1 in the moclobemide group. Sertraline also resulted in a significantly (p < 0.05) greater degree of improvement at the endpoint, compared with moclobemide, in the proportion of remitters on the HAMA (total score < or = 7), ADDS Category IID (Rejection Sensitivity), Leeds Sleep Factor 4 (Integrity of Behaviour Following Awakening), and on three dimensions of the BQOLB (Energy/Vitality, Social Interaction and Life Satisfaction). There were no other significant differences between treatment groups. Overall, both medications were well tolerated. In this study, both sertraline and moclobemide improved the symptoms of atypical depression.

Necrotising fasciitis as a complication of botulinum toxin injection.

PURPOSE: To highlight the need for early diagnosis and treatment of the rare condition of necrotising fasciitis as a complication of botulinum toxin injection, and to illustrate that injections in immunocompromised patients carry a rare but serious risk. RESULTS AND METHODS: A case report is presented of an 80-year-old woman suffering from blepharospasm and chronic myeloid leukaemia, who developed necrotising fasciitis 3 days after a botulinum toxin injection. CONCLUSIONS: Chronic debilitating processes such as diabetes, alcoholism and polymyositis have been suggested as predisposing factors in the development of necrotising fasciitis. We believe this is the first reported case of necrotising fasciitis occurring secondary to a botulinum toxin injection. The fact that this infection extended through the fascial planes and led to the death of muscle was, probably, because an inoculum was introduced directly into the muscle at the time of botulinum toxin treatment. This may have led to its deep spread and difficulty in debriding the area. Chronic myeloid leukaemia does not in itself cause significant immunosuppression, but our patient was on anti-proliferative treatment and had a low leucocyte count, which may have been a predisposing factor in this case.

Tardive dyskinesia: a review.

OBJECTIVE: To review recent research findings on tardive dyskinesia (TD) with relevance to clinical practice. METHOD: TD is a syndrome of involuntary movements that can occur in association with chronic neuroleptic use. It is of unknown pathophysiology. It can be irreversible, is cosmetically disfiguring, and can be functionally disabling. RESULTS: There is as yet no treatment of demonstrated efficacy for TD. It is an iatrogenic disorder whose incidence is increased by age and total cumulative dose of typical neuroleptics. It has been the source of successful litigation in some jurisdictions but, until very recently, there has been no effective antipsychotic agent without this effect. CONCLUSION: This litigation in some jurisdictions has been a major impetus to the development of novel antipsychotic agents. It is less well known that a similar, possibly identical, movement disorder occurs spontaneously particularly in the elderly and in patients with schizophrenia, and that TD is often reversible.

Talbot effect and Cornu's spiral.

Cornu's spiral is used in the testing and extension of a recent explanation of the Talbot effect, which occurs in the Fresnel domain. The results confirm all parts tested. They also indicate that each band of a Talbot plane is controlled primarily by light from only a few slits of the grating, contrary to earlier assumptions. Increases in slit width are found to limit the number of Talbot planes that can be observed.

Talbot plane patterns: grating images or interference effects?

It has been widely said that with the Talbot effect a grating makes images of itself unaided. However, the effect as produced by simple amplitude gratings was recently redefined in terms of interference-pattern visibility or contrast instead of self-imaging. Then, by starting with a pair of slits instead of the usual infinite grating, a new and more general description of the effect was developed. Now numerical methods and tools from physical optics are used further to characterize the influences of the grating, light parameters, and the position of the plane of observation on pattern form, fine structure, band positions, and phases. It is found that none of the patterns in the Talbot planes actually approximates grating images in terms of all of these properties. Hence the Talbot effect should be defined in terms of interference effects, not grating images.

Talbot effect reinterpreted: reply to comment.

This Technical Note is a reply to the comment concerning our paper on the Talbot effect reinterpreted by P. Szwaykowski [Appl. Opt. 32, 3466-3467 (1993)].

Talbot effect reinterpreted.

Pattern generation in Talbot planes has generally been interpreted in terms of image formation, the repetitive slits are said to make repetitive images of themselves. In this context, Fourier optics developments have correctly predicted the positions of some but not all of the Talbot planes. Now, wave-optics methods are used to obtain general expressions for the positions of all known Talbot planes and the lateral positions of the diffraction fringes within them. These equations predict the key features of the Talbot effect, and they better relate multiple-slit diffraction in the Fresnel and Fraunhofer domains.

Phenytoin dosage predictions in paediatric patients.

Phenytoin dosing in paediatric patients is complicated both by alterations in patient requirements due to growth and maturation changes and by the capacity-limited characteristics of phenytoin metabolism. This study examines 2 pharmacokinetic methods to adjust phenytoin dosage based on a single dosing-rate/steady-state serum phenytoin concentration pair. A Bayesian forecaster and a fixed parameter [rate of metabolism (Vmax)] method were examined with previously published sets of a priori parameter estimates. The fixed Vmax method was utilised with the parameter derived from native Japanese (method 1), US Caucasian (method 2) and European (method 3) patients. The Bayesian forecaster used a priori parameter estimates obtained from native Japanese (method 4) and European (method 5) patients. Each method was examined retrospectively in 34 paediatric patients with a total of 48 predictions possible. Measures of absolute predictability, bias (mean error, % dose) and precision (root mean squared error, % dose), were -3.58/12.2, -1.51/12.2, 4.06/9.96, -4.38/13.2, and -3.10/11.5, for methods 1, 2, 3, 4 and 5, respectively. There was no significant difference among the 5 methods. However, the Bayesian algorithm tended to be more robust over a broad range of situations, providing predictions in all cases. The fixed Vmax methods could not provide predictions in every case. Finally, all methods had a significant number of overpredictions of dosage. Poorer results were observed when prediction of steady-state serum concentrations were performed, partly due to the retrospective nature of the study. We conclude that close monitoring of patients, regardless of the method chosen to adjust dosage, is recommended.

Light propagation in moderately dense particle systems: a reexamination of the Kubelka-Munk theory.

A numerical method (NM) is developed to characterize radiative transfer in a moderately dense particle population, i.e., a suspension of concentration of <1-10% by volume. It assumes that the particles scatter in accord with the Mie equations, that the propagation of light over short distances is in accord with the exponential transmission law, and that the light flows in many (thirty-six) directions. For representative systems, predictions of the Kubelka-Munk theory (KMT) are compared with those of the NM; partial agreement is found. While this theory can be a useful tool, radiative transport in representative samples is found not to obey strictly either the assumptions for writing the basic differential equations of the KMT or those for solving them. The movement of diffuse light through an attenuating system is found to often collimate it, not to make it more diffuse as expected. This effect causes errors in absolute KMT predictions. New transport equations, like Schuster's, with four parameters instead of two are written and solved to obtain some new KMT equations. Their predictions are compared with those of the NM.

Hunger perceptions and satiety responses among normal-weight bulimics and normals to a high-calorie, carbohydrate-rich food.

The hunger perceptions and satiety responses to a high-calorie, carbohydrate-rich food among 10 normal-weight females who met the DSM-III criteria for bulimia were compared with 10 normal-weight females who denied a current or past history of eating or weight disorders. As indicated by self-report responses on the Hunger-Satiety Questionnaire, bulimics did not differ from the normals in their perceptions of hunger sensations. Differences, however, were detected in the responses following eating. Most notably, the bulimics reported feelings of irritability, nervousness, tenseness and depression which persisted 30 minutes later. These findings and directions for future research are discussed.

A components analysis of biofeedback in the treatment of fecal incontinence.

Fecal incontinence is a socially disabling symptom for which rectosphincteric biofeedback has been reported to be dramatically effective. The most commonly employed biofeedback procedure incorporates three separate and potentially effective components: exercise of the external sphincter muscle, training in discrimination of rectal sensations, and training synchrony of the internal and external sphincter responses. This paper reports the results of single case experiments employed with eight incontinent patients to examine the contributions of each of these components. All eight patients improved, but only one required the biofeedback procedure as it was originally described. Three responded to sensory discrimination training, one to exercise training, and one to the training of synchronous sphincteric responses; three recovered independently of the effects of biofeedback. Despite the achievement of continence, the rectosphincteric reflexes following treatment continued to be abnormal in every case. These findings suggest that the character of the external sphincter response to rectal distension is an unreliable index of sphincter function and that exercise and sensory discrimination training procedures are effective for some cases of fecal incontinence.

Cognitive versus behavioral procedures in cognitive-behavior therapy: a critical review of the evidence.

During the past decade there has been an increasing emphasis on cognition in psychology and behavior therapy. This movement has spawned several distinctive cognitive therapies. While those therapies do employ innovative cognitive treatment procedures, they often do so in the context of well-established behavioral treatment procedures which may or may not be acknowledged by the label "cognitive-behavior therapy". This paper addresses the question of whether cognitive therapy is an evolutionary or revolutionary development from behavior therapy and critically evaluates the evidence for the efficacy of procedures specific to cognitive therapy.

Vomiting as a learned weight-control technique in bulimia.

Twenty-seven consecutive patients presenting with binge eating and vomiting were systematically questioned about the circumstances surrounding the onset of their vomiting habit. Twenty-four were able to specify and describe a particular incident to which they attributed the idea of vomiting as a weight-control method. The nature of the reported incidents supports the hypothesis that vomiting in those patients is a learned maladaptive behavior which is frequently inadvertently taught by well-meaning friends, relatives and professionals. These findings indicate the necessity of evaluating the risks as well as the benefits of public education.

Blood platelet aggregometer: predicted effects of aggregation, photometer geometry, and multiple scattering.

The in vitro aggregation of blood platelets is usually monitored with a visible light transmittance photometer (aggregometer). These cells in plasma are large (alpha = 2pi a/lambda approximately = 16) soft (m = 1.04) particles. The factors which significantly influence transmittance include the inherent scattering properties, multiple scattering, and photometer design. Now scattering theory and numerical methods for radiative transfer are used to survey how aggregation should influence transmittance as measured with various photometers. The results should help expand the analytical power of the transmittance photometer as a tool for monitoring aggregation. Evidence is also presented that scattering by aggregates of aerosol particles, which are of a higher relative refractive index, should also be adequately predicted by these approximate methods.